Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 1996
Randomized Controlled Trial Clinical TrialHypothermic versus normothermic cardiopulmonary bypass: influence on circulating adhesion molecules.
Cardiopulmonary bypass (CPB) may result in a whole-body inflammatory response with the risk of subsequent development of organ failure. Leukocyte-endothelial binding followed by neutrophil migration appear to play a central role. This process is markedly influenced by adhesion molecules. Whether plasma levels of circulating adhesion molecules are beneficially influenced by hypothermic CPB was studied in patients undergoing either hypothermic or normothermic CPB. ⋯ Plasma levels of circulating adhesion molecules sELAM-1, sICAM-1, and sVCAM-1 did not differ between hypothermic and normothermic CPB, indicating no differences in endothelial activation between the two groups. Only sGMP-140 plasma levels were increased more after hypothermic CPB. Additional influences of hypothermia on the coagulation system might have contributed to the higher sGMP-140 plasma levels of these patients. The definite role of circulating adhesion molecules in cardiac surgery patients remains to be elucidated.
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J. Cardiothorac. Vasc. Anesth. · Apr 1996
Afterdrop after hypothermic cardiopulmonary bypass: the value of tympanic membrane temperature monitoring.
After weaning from cardiopulmonary bypass (CPB), a decrease in nasopharyngeal temperature (NPT) occurs (afterdrop). The pathophysiology of the afterdrop remains unclear: It might be caused by either inadequate total body rewarming on CPB or to heterogenous distribution of heat during CPB, with subsequent redistribution of heat from the warmer core to the cooler shell tissues. The study objectives were (1) to determine whether post-CPB afterdrop is the result of a negative CPB thermal balance, and (2) to investigate which sites (if any) could best predict the afterdrop. ⋯ It is suggested that besides post-CPB heat loss, redistribution of heat may be involved in the mechanism of the afterdrop and that measurements of tympanic membrane and cutaneous thigh temperatures are the best monitors of adequacy of rewarming during CPB.
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J. Cardiothorac. Vasc. Anesth. · Apr 1996
Comparative StudyHepatic blood flow and right ventricular function during cardiac surgery assessed by transesophageal echocardiography.
To determine the effect of cardiopulmonary bypass (CPB) on hepatic blood flow (HBF) and the hepatic venous flow pattern. ⋯ TEE represents a useful tool in assessing changes in the hepatic blood flow. The HBF was reduced during hypothermic CPB, but this was not accompanied by a reduced pHi. The changes in the venous flow pattern with a reduction in systolic flow could be explained by impaired atrial relaxation.
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J. Cardiothorac. Vasc. Anesth. · Apr 1996
Cardiac complications in noncardiac surgery: value of dobutamine stress echocardiography versus dipyridamole thallium imaging.
The objective of this study was to determine the relative value of dobutamine stress echocardiography (DSE) and dipyridamole thallium imaging (DT) in the preoperative assessment of cardiovascular risk before noncardiac surgery. ⋯ The ability of DSE to predict major cardiac complications related to noncardiac surgery appears to be similar to DT and may be used as an alternative to DT imaging in the preoperative risk assessment of patients undergoing noncardiac surgery.
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J. Cardiothorac. Vasc. Anesth. · Apr 1996
Comparative StudyValidation of a test of competence in transesophageal echocardiography.
A test was developed that is based on intraoperative findings to evaluate knowledge of intraoperative echocardiography. This study examines the performance of attending anesthesiologists and residents at various levels of training in order to validate the test's ability to measure physician competence in intraoperative echocardiographic diagnosis. ⋯ Test performance differed according to level of experience. This suggests that the test is a valid measure of intraoperative transesophageal echocardiography competence.